Best Practice

The Swallowing Rehabilitation Research Laboratory (SRRL) crafted the following best practice recommendations:

VFSS Best Practice Recommendations

Standardization of all aspects of a videofluoroscopy is critical to ensure that results can be compared across: 1) time points (e.g. pre vs. post), 2) individuals, 3) clinicians, 4) research studies, and 5) to translate research to clinical practice. We strongly recommend adopting standard approaches to each of the following aspects of videofluoroscopy below. To see a summary of VFSS best practice recommendations, click here.

Barium Recipe Information

Professor Steele is an advocate of using standardized stimuli for assessment in videofluoroscopy.  Bracco Varibar is an FDA-approved commercially-approved barium product that is available in the United States, which comes in different liquid consistencies and is specifically intended for use in oropharyngeal swallowing examinations. However, Varibar is not currently approved for clinical use or available in many countries. If you are unable to access Varibar and are looking for guidance on how to prepare barium according to standard recipes, click here.

Videofluoroscopy Frame Rate

In a videofluoroscopy exam, the aim is to capture the highest image quality possible while being responsible about limiting unnecessary radiation exposure. For information on videofluoroscopy frame rate, click here.

VFSS Analysis

In April 2019, the Swallowing Rehabilitation Research Lab (SRRL) published our first article on videofluoroscopic swallow study (VFSS) reference values in healthy swallowing, across the range from thin to extremely thick liquids according to the IDDSI framework. The VFSS analysis process was titled the ASPEKT Method (Analysis of Swallowing Physiology: Events, Kinematics and Timing).

In November 2019, the SRRL introduced the ASPEKT-C Method (Analysis of Swallowing Physiology: Events, Kinematics and Timing for Use in Clinical Practice), a simplified VFSS analysis approach to assist clinicians in identifying the underlying mechanisms leading to impaired swallowing safety and efficiency.

STARTED: Dysphagia Research Standards

The Started Framework, which stands for STAndards for Rigor and TransparEncy in Dysphagia Research, has been developed over the past year as a collaboration across 6 dysphagia research labs.  The tool involves a series of questions that can be used to help evaluate rigor and transparency of dysphagia research designs using a variety of different measurement techniques.  The tool can be used not only in the task of literature review, but also for helping researchers to plan their studies, and for manuscript reviewers to use when evaluating articles for publication. 

The BETA version of the app can be found here: